AB0613 Vascular Events and Associated Factors in ANCA-associated Vasculitis: Analysis of 237 patients with Long-term Follow-up
Authors: M. Bektaş, B. Ince, S. Zarali, U. A. Gulseren, E. Ük, Y. Yalçinkaya, B. Artim-Esen, A. Gül, M. Inanc
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with ANCA-associated vasculitis (AAV) reported to have an increased risk of vascular events (VE) compared to general population [1]. However, studies on risk factors for the development of VE in AAV patients (pts) are limited. Objectives In our study we aimed to evaluate the frequency, risk factors and mortality risk of VE pts with AAV. Methods In this study we retrospectively evaluated 287 pts with AAV. Patients with EGPA (n=33) were not included and 17 pts were excluded due to missing data. Arterial vascular events (a-VE) were recorded as myocardial infarction, unstable angina pectoris, peripheral artery disease, need for revascularization and cerebrovascular accident. Deep venous thrombosis and pulmonary embolism were recorded as venous thrombotic events (VTE). History of a-VE and/or VTE were grouped as all VE. ANCA test results were analyzed based on IFA and/or Elisa results and divided into two serological groups; c-ANCA/PR3 + (positive) and p-ANCA/MPO + . Results Data of 237 pts (46 % male) was analyzed. Mean age at diagnosis was 55.6±14 (range; 17-88) years and median disease duration was 77 (range; 3-255) months. Of those pts, 173 (73 %) had GPA and 64 (27 %) had MPA. ANCA results were available in 230 pts; 122 were c-ANCA/PR3 + (53.5 %), 85 were p-ANCA/MPO + (37 %) and 22 were ANCA negative (ANCA - ) (9.5 %). The most common organ involvements were kidneys (75.8 %) and lower respiratory tract (74.4 %). Overall, 22 % (n=52) of the pts developed VE, 17 % (n=40) a-VE, 9 % (n=21) VTE and 3.8 % (n=9) both a-VE and VTE. In univariate analysis; development of VE was significantly higher in males, pts with c-ANCA/PR3 and pts with higher baseline CRP levels, GFR&lt;50 mL/min, history of smoking, severe infection, higher VDI score. Development of a-VE was higher in pts with males, advanced age, pts with c-ANCA/PR3, history of smoking, higher VDI score, GFR&lt;50 mL/min. Additionally, mortality was increased in pts with VE and a-VE. In multivariate analysis; while VE were associated with smoking [95 % CI:1.7-21; OR:6], c-ANCA/PR3 positivity [95 % CI: 1.15-92; OR:10.3] and higher VDI score [95 % CI:1.007-2.4; OR:1.5]; a-VE were associated with advanced age [95 % CI:1.002-1.08; OR:1.04], higher VDI score [95 % CI:1.3-2; OR:1.6] and c-ANCA/PR3 + [95 % CI:1.06-8.6; OR:3]. Development of VTE was associated with higher VDI score (p&lt;0.001) in univariate and multivariate analysis [95 % CI: 1.2-1.8; OR:1.5]. In survival analysis, mortality rate was significantly higher in pts who had a history of VE (Log-Rank: p=0.04). Conclusion Our observational data of more than 5 years of follow-up revealed that, one in five pts with AAV developed VE after diagnosis. The risk of VE was significantly higher in c-ANCA/PR3 + pts, smokers and pts with high VDI scores. Older age increased the risk of a-VE. Mortality was increased in AAV pts with VE after diagnosis. Additional studies needed to delineate the mechanism of VE in AAV and precautions should be undertaken to avoid morbidity and mortality. Table 1. Factors associated with vascular events in pts with AAV Univariate analysis Variables VE+ (n=52 ) VE- (n=185 ) p value (OR) (95 % CI ) Age* 58.8±14.5 54.9±14 0.08 (0.99-1.04) Gender, male Ɨ 31 (60) 78 (42) 0.03 (5) (1.08-3.8 ) Diagnosis Ɨ GPA (n=173) 40 (23) 133 (77) 0.5 MPA (n=64) 12 (19) 52 (81) ANCA status Ɨ c-ANCA/PR3 33 (27) 89 (73) 0.045 (4) (1.007-4.2 ) p-ANCA/MPO 13 (15) 72 (85) Baseline CRP (mg/L) ĸ 73 (85) 48 (89) 0.05 (1-1.009 ) GFR&lt;50 ml/min Ɨ 24 (47) 57 (31) 0.03 (4.7 ) BVAS score* 19±7 16.3±7 0.06 (1-1.1) Smoking history (ever) Ɨ 19/45 (42) 34/162 (21) 0.004 (8.3) (1.4-5.6 ) Cumulative steroid (MP) dosage (g/12 month) ĸ 7.9 (17) 7.5 (8) 0.8 Relapse Ɨ 22/49 (45) 58/180 (32) 0.1 Severe infection Ɨ 23/46 (50) 57/168 (34) 0.046 (4) (1.006-3.8 ) VDI score* 4.8±2.7 2.4±1.7 &lt;0.001 (1.4-1.96 ) Remission at 6. month Ɨ 19 (56) 85 (68) 0.2 Mortality Ɨ 15 (29) 27 (14.6) 0.02 (5.7) (1.1-4.9 ) *mean±std dev Ɨ n, % ĸ median, interquartile range . OR: Odds ratio Figure 1. Comparison of mortality rate between pts had VE and had not. Log-rank: p=0.039 References [1]Wallace et al. All-cause and cause-specific. Rheumatology, 2020 Disclosure of Interests None declared